Individual
JORDAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11010 DAVID ST STE A, GULFPORT, MS 39503-3481
(228) 832-8327
Mailing address
11010 DAVID ST STE A, GULFPORT, MS 39503-3481
(228) 832-8327
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5517
MS
Other
Enumeration date
07/02/2014
Last updated
08/22/2023
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